Acute ischaemic stroke associated with SARS-CoV-2 infection in North America.

BACKGROUND: To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome. METHODS: Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications. RESULTS: A total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, p<0.001), diabetes mellitus (aOR: 2.66, 95% CI 1.16 to 6.09, p=0.021), higher NIHSS at admission (aOR: 1.08, 95% CI 1.02 to 1.14, p=0.006), LVO (aOR: 2.45, 95% CI 1.04 to 5.78, p=0.042), and higher NLR level (aOR: 1.06, 95% CI 1.01 to 1.11, p=0.028) were significantly associated with poor functional outcome. CONCLUSION: There is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.

BRAF inhibition and the spectrum of granulomatous reactions.

V-raf murine sarcoma viral oncogene homolog B1 (BRAF) inhibitors have emerged as a promising targeted therapy for malignancies with BRAF mutations, particularly metastatic melanoma. However, granulomatous reactions (GRs), including sarcoidosis and sarcoid-like reactions, have been reported as a consequence of BRAF inhibition. It is important to adequately characterize these GRs, including cutaneous manifestations and systemic involvement, in order to guide investigations and management. A literature review was conducted to characterize the spectrum of GRs associated with BRAF inhibitors, identifying 55 reactions affecting 51 patients, with 37 reactions limited to cutaneous involvement. Further, a possible correlation with cancer response, mechanisms of granuloma formation, and a proposed workup and management approach for these GRs are presented.

Emerging off-label esthetic uses of botulinum toxin in dermatology.

Botulinum toxin is a neurotoxic protein produced by Clostridium botulinum, the bacterium responsible for botulism. Botulinum toxin was first used for therapeutic indications in the 1970s for the treatment of strabismus. With greater understanding of its underlying physiology and safety profile, the use of botulinum toxin has now expanded to a range of cosmetic and medical indications. We performed a systematic review of current literature on the applications of botulinum toxin on off-label esthetic uses. Electronic databases were searched for original published studies including randomized trials, observational or cohort studies, as well as relevant case reports. To add to the body of evidence, our review summarizes and synthesizes key study characteristics, results, and level of evidence for each use case. Although the body of evidence remains weak, there is increasing support for the use of botulinum toxin in emerging off-label esthetic uses of botulinum toxin in dermatology.

Infectious outcomes after splenectomy for trauma, splenectomy for disease and splenectomy with distal pancreatectomy.

INTRODUCTION: The spleen provides a unique immune function in its production of opsins directed against encapsulated bacteria. Splenectomy, therefore, increases the risk of infections in patients as well as post-operative complications. This study aims to assess the risk of post-operative complications within 5 years of splenectomy by indication for splenectomy: trauma, disease, or in association with a distal pancreatectomy for pancreatic disease. The relationship between vaccination and infectious outcomes was also investigated. METHODS: This study is a review of splenectomy cases between June 2005 and June 2015 at a single institution. Infection, splenectomy indication, and vaccination history were identified from electronic medical records and lab test confirmations. Data was analyzed using Student's t test for continuous variables, the Mann-Whitney U test for ordinal variables, and a Chi-square/Fisher exact test for categorical variables. RESULTS: A total of 106 splenectomy patients were included: 35 traumatic (74% male) and 71 non-traumatic causes (42% male) with no significant difference in age. There were no statistical differences in complications during splenectomy and vaccination administration between the splenectomy indication groups: trauma, disease, and with distal pancreatectomy. There was a statistically significant higher infection rate within 5 years post-splenectomy in the non-traumatic vs traumatic group (42% vs 14.0%, p = 0.0040) with majority gastrointestinal (7/38) and respiratory (5/38) and surgical wound infections (3/38) observed in non-traumatic versus traumatic, respectively. CONCLUSION: Results from data analysis show a statistically significant difference in rates of infection within 5 years post-operatively between traumatic versus non-traumatic indications for splenectomies, with the non-traumatic group experiencing a higher rate of infectious outcomes. The non-traumatic group included patients with disease and distal pancreatectomy indications. This suggests that patients who have non-traumatic causes may be at a higher risk of developing infections following splenectomy procedure. Additionally, vaccinations did not appear to have a protective effect.

Biologics for pediatric psoriasis: A systematic review and meta-analysis.

BACKGROUND: Biologics represent a promising treatment for children with moderate-to-severe psoriasis. Randomized control trials (RCTs) have been published evaluating different biologics in children with psoriasis, but no summative review exists. OBJECTIVE: To summarize data from existing RCTs to assess the efficacy and safety of biologics in the management of pediatric psoriasis. METHODS: A systematic review and meta-analysis of RCTs was performed from Medline, Embase, PubMed, the Cochrane Central Register of Controlled Trials, and the American College of Physicians Journal Club from inception to November 2020. Random-effects models were used to estimate the pooled effect size. RESULTS: Five RCTs assessing adalimumab, etanercept, ixekizumab, secukinumab, and ustekinumab were included (768 patients). The odds ratio of achieving a 75% improvement in Psoriasis Area and Severity index score was 12.37 (95% CI: 6.23-24.55) at initial follow-up, defined as 12-16 weeks of treatment. The odds ratio of any adverse event was 0.95 (95% CI: 0.51-1.80) at initial follow-up, in patients treated with biologics when compared to placebo or a non-biologic agent. Limitations of this study include heterogeneity in both the study design and the biologics investigated between the RCTs included in the meta-analysis. CONCLUSION: Biologic therapy for pediatric patients with moderate-to-severe psoriasis has high efficacy and a favorable side effect profile.

Bladder infusion versus standard catheter removal for trial of void: a systematic review and meta-analysis.

PURPOSE: To compare the efficacy and time-to-discharge of two methods of trial of void (TOV): bladder infusion versus standard catheter removal. METHODS: Electronic searches for randomized controlled trials (RCTs) comparing bladder infusion versus standard catheter removal were performed using multiple electronic databases from dates of inception to June 2020. Participants underwent TOV after acute urinary retention or postoperatively after intraoperative indwelling catheter (IDC) placement. Quality assessment and meta-analyses were performed, with odds ratio and mean time difference used as the outcome measures. RESULTS: Eight studies, comprising 977 patients, were included in the final analysis. Pooled meta-analysis demonstrated that successful TOV was significantly higher in the bladder infusion group compared to standard TOV (OR 2.41, 95% CI 1.53-3.8, p = 0.0005), without significant heterogeneity (I2=19%). The bladder infusion group had a significantly shorter time-to-decision in comparison to standard TOV (weighted mean difference (WMD)-148.96 min, 95% CI - 242.29, - 55.63, p = 0.002) and shorter time-to-discharge (WMD - 89.68 min, 95% CI - 160.55, - 18.88, p = 0.01). There was no significant difference in complication rates between the two groups. CONCLUSION: The bladder infusion technique of TOV may be associated with a significantly increased likelihood of successful TOV and reduced time to discharge compared to standard TOV practices.

Rate of dissemination and prognosis in early and advanced stage colorectal cancer based on microsatellite instability status: systematic review and meta-analysis.

INTRODUCTION: For the past two decades, microsatellite instability (MSI) has been reported as a robust clinical biomarker associated with survival advantage attributed to its immunogenicity. However, MSI is also associated with high-risk adverse pathological features (poorly differentiated, mucinous, signet cell, higher grade) and exhibits a double-edged sword phenomenon. We performed a systematic review and meta-analysis to evaluate the rate of dissemination and the prognosis of early and advanced stage colorectal cancer based on MSI status. METHODS: A systematic literature search of original studies was performed on Ovid searching MEDLINE, Embase, Cochrane Database of Systematic Reviews, American College of Physicians ACP Journal Club, Database of Abstracts of Reviews of Effects DARE, Clinical Trials databases from inception of database to June 2019. Colorectal cancer, microsatellite instability, genomic instability and DNA mismatch repair were used as key words or MeSH terms. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Data were pooled using a random-effects model with odds ratio (OR) as the effect size. Statistical analysis was performed using RevMan ver 5.3 Cochrane Collaboration. RESULTS: From 5288 studies, 136 met the inclusion criteria (n = 92,035; MSI-H 11,746 (13%)). Overall, MSI-H was associated with improved OS (OR, 0.81; 95% CI 0.73-0.90), DFS (OR, 0.73; 95% CI 0.66-0.81) and DSS (OR, 0.69; 95% CI 0.52-0.90). Importantly, MSI-H had a protective effect against dissemination with a significantly lower rate of lymph node and distant metastases. By stage, the protective effect of MSI-H in terms of OS and DFS was observed clearly in stage II and stage III. Survival in stage I CRC was excellent irrespective of MSI status. In stage IV CRC, without immunotherapy, MSI-H was not associated with any survival benefit. CONCLUSIONS: MSI-H CRC was associated with an overall survival benefit with a lower rate of dissemination. Survival benefit was clearly evident in both stage II and III CRC, but MSI-H was neither a robust prognostic marker in stage I nor stage IV CRC without immunotherapy.

Perils & pearls of purchasing sun protection over the internet: A google project.

BACKGROUND/PURPOSE: Sunscreen use has been shown to reduce the incidence of skin cancers. Internet purchasing allows access to internationally sourced sunscreens, despite varying accepted active ingredients and regulations around the world. AIMS/OBJECTIVES: To determine the compliance of international sunscreen products advertised on the internet with the current Australian sunscreen standard (AS/NZS 2604:2012). MATERIALS AND METHODS: Six sunscreen-related search queries were executed on Google between January-November 2018. Qualitative analysis of the search results to determine compliance with the current Australian sunscreen standard (AS/NZS 2604:2012) was performed by collecting descriptive data, including listed active ingredients of each advertised product. These were compared against the AS/NZS 2604:2012 list of permitted active ingredients. The compliance status of each product, and reasons for non-compliance were annotated. A multiple regression contingency table test was performed to determine whether compliance was associated with the products' country of origin, and a post hoc analysis was performed to identify countries with significant differences in discrepancy in compliance rate. RESULTS: Execution of the sunscreen-related search queries on Google generated 1350 results. Only 613 of the 1291 (47.5%) included products were compliant with the AS/NZS 2604:2012 permitted sunscreen active ingredients. 552 of 1291 products were non-compliant due to insufficient information advertised. Australia, India and South Korea had significantly lower than expected compliance rates. CONCLUSIONS: Online marketing of sunscreen products from other countries has a significantly lower than expected compliance rate with the AS/NZS 2604:2012 permitted sunscreen active ingredients, with many lacking the disclosure of the active ingredients. Advertising regulations for online suppliers need to be tightened to ensure that online consumers purchasing sunscreen products can make informed decisions, as the international E-commerce market rapidly expands.

Comparable dislocation and revision rates for patients undergoing total hip arthroplasty with subsequent or prior lumbar spinal fusion: a meta-analysis and systematic review.

BACKGROUND: There is a known correlation between the procedures of lumbar spinal fusion (LSF), total hip arthroplasty (THA) and the complication of hip dislocation and revision occurring in patients. However there is no consensus as to whether the risk of this complication is higher if THA is performed before or after LSF. This meta-analysis aims to determine the influence of surgical sequence of lumbar spinal fusion and total hip arthroplasty on the rates of hip dislocation and revisions. METHODS: A meta-analysis was conducted with a multi-database search (PubMed, OVID, EMBASE, Medline) according to PRISMA guidelines on 27th May 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model. FINDINGS: A total of 25,558 subsequent LSF and 43,880 prior LSF THA patients were included in this study. There was no statistically significant difference in all-cause revisions (OR = 0.86, 95%CI: 0.48-1.54, p = 0.61), dislocation (OR = 0.82, 95%CI: 0.25-2.72, p = 0.75) or aseptic loosening (OR = 1.14, 95%CI: 0.94-1.38, p = 0.17) when comparing patients receiving LSF subsequent versus prior to THA. CONCLUSION: Lumbar spinal fusion remains a risk factor for dislocation and revision of total hip arthroplasties regardless of whether it is performed prior to or after THA. Further preoperative assessment and altered surgical technique may be required in patients having THA who have previously undergone or are likely to undergo LSF in the future. EVIDENCE LEVEL: Level II, Meta-analysis of homogeneous studies.

Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.

Background Osteoporotic vertebral compression fractures (OVCFs) are prevalent, with associated morbidity and mortality. Vertebral augmentation (VA), defined as either vertebroplasty and/or balloon kyphoplasty (BKP), is a minimally invasive surgical treatment to reduce pain and further collapse and/or renew vertebral body height by introducing bone cement into fractured vertebrae. Nonsurgical management (NSM) for OVCF carries inherent risks. Purpose To summarize the literature and perform a meta-analysis on the mortality outcomes of patients with OVCF treated with VA compared with those in patients treated with NSM. Materials and Methods A single researcher performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. Online scientific databases were searched in April 2018 for English-language publications. Included studies investigated mortality in patients with OVCF with VA as the primary intervention and NSM as the comparator. A meta-analysis was performed for studies that reported hazard ratios (HRs) and 95% confidence intervals (CIs). HR was used as a summary statistic and was random-effect-models tested. The χ2 test was used to study heterogeneity between trials, and the I2 statistic was calculated to estimate variation across studies. Results Of the 16 included studies, eight reported mortality benefits in VA, seven reported no mortality difference, and one reported mixed results. Seven studies were included in a meta-analysis examining findings in more than 2 million patients with OVCF (VA = 382 070, NSM = 1 707 874). The pooled HR comparing VA to NSM was 0.78 (95% CI: 0.66, 0.92; P = .003), with mortality benefits across 2- and 5-year periods (HR = 0.70, 95% CI: 0.69, 0.71, P < .001; and HR = 0.79, 95% CI: 0.62, 0.9999, P = .05; respectively). Balloon kyphoplasty provided mortality benefits over vertebroplasty, with HRs of 0.77 (95% CI: 0.77, 0.78; P < .001) and 0.87 (95% CI: 0.87, 0.88; P < .001), respectively. Conclusion In a meta-analysis of more than 2 million patients, those with osteoporotic vertebral compression fractures who underwent vertebral augmentation were 22% less likely to die at up to 10 years after treatment than those who received nonsurgical treatment. © RSNA, 2020 See also the editorial by Jennings in this issue.

Treatment Strategies and Related Outcomes for Brain Arteriovenous Malformations in Children: A Systematic Review and Meta-Analysis.

OBJECTIVE. The objective of this study was to assess the available evidence in the literature regarding treatment outcomes for pediatric patients with brain arteriovenous malformation (bAVM) with the aim of providing practice guidelines for treatment decisions and highlighting research areas that need attention. MATERIALS AND METHODS. Keyword searches for studies published from January 1, 1981, to April 16, 2018, were performed in MEDLINE, Embase, and Web of Science. Predefined inclusion criteria were used to identify studies. Poisson regression analysis for associations between patient and bAVM characteristics and treatment outcomes. RESULTS. We identified 34 articles comprising 2158 children with bAVM who underwent treatment or observation. The mean age of the study cohort was 12.0 ± 1.6 (SD) years, and 48.1% of the patients were female; 64.3% of bAVMs were hemorrhagic at presentation. The mean follow-up was 50.6 ± 32.3 months. Overall, the meta-analysis of pooled data showed an obliteration rate of 69.8% (95% CI, 62.9-75.9%), recurrence rate of 2.2% (95% CI, 1.1-4.3%), and mortality rate of 2.4%. The pooled complication rate was 22.5% (95% CI, 15.7-31.1%) after surgery, 26.4% (95% CI, 15.2-41.9%) after embolization, and 27.1% (95% CI, 18.1-38.4%) after radiosurgery. Mortality was not associated with age, sex, or hemorrhage; however, recurrence after treatment was inversely associated with age. Complication and mortality rates were reduced for multimodal treatments. For patients with bAVM treated with observation only, complication and mortality rates were 35.9% and 23.5%, respectively. CONCLUSION. Multimodality treatments for pediatric bAVM had lower mortality and complication rates than individual treatments. However, there is a lack of evidence for long-term outcomes. The mortality rate was highest in conservatively managed patients (i.e., observation only). Further research directly comparing different treatment modalities for recurrence and complications is warranted. Gathering data prospectively through multiinstitutional registries will be key to provide strong evidence.

Endovascular thrombectomy for tandem acute ischemic stroke associated with cervical artery dissection: a systematic review and meta-analysis.

PURPOSE: Strokes associated with cervical artery dissection have been managed primarily with antithrombotics with poor outcomes. The additive role of endovascular thrombectomy remains unclear. The objective was to perform systematic review and meta-analysis to compare endovascular thrombectomy and medical therapy for acute ischemic stroke associated with cervical artery dissection. METHODS: Studies from six electronic databases included outcomes of patient cohorts with acute ischemic stroke secondary to cervical artery dissection who underwent treatment with endovascular thrombectomy. A meta-analysis of proportions was conducted with a random effects model. Modified Rankin score at 90 days (mRS 0-2) was the primary outcome. Other outcomes included proportion of patients with thrombolysis in cerebral infarction (TICI) 2b-3 flow, 90-day mortality rate, and 90-day symptomatic intracerebral hemorrhage (sICH) rate. RESULTS: Six studies were included, comprising 193 cases that underwent thrombectomy compared with 59 cases that were managed medically. Successful recanalization with a pooled proportion of thrombolysis in cerebral infarction (TICI) 2b-3 flow in the thrombectomy group was 74%. Favorable outcome (mRS 0-2) was superior in the pooled thrombectomy group (62.9%, 95% CI 55.8-69.5%) compared with medical management (41.5%, 95% CI 29.0-55.1%, P = 0.006). The pooled rate of 90-day mortality was similar for endovascular vs medical (8.6% vs 6.3%). The pooled rate of symptomatic intracranial haemorrhage (sICH) did not significantly differ (5.9% vs 4.2%, P = 0.60). CONCLUSIONS: Current data suggest that endovascular thrombectomy may be an option in patients with acute ischemic stroke due to cervical artery dissection. This requires further confirmation in higher quality prospective studies.

Benign intracranial hypertension in a patient treated with ustekinumab for psoriasis.

Ustekinumab is a monoclonal antibody, which binds the p40 subunit of IL-12 and IL-23 so they are unable to bind to their receptors, ultimately reducing T-cell-mediated inflammation in psoriasis. Studies and cases have focused on the risk of infection and malignancy associated with the use of biologics medications; however, there have been limited data available on the potential neurological adverse effects of biologics. We report the case of a 44-year-old female with a longstanding history of psoriasis who developed benign intracranial hypertension while on ustekinumab for her psoriasis.

A case report of temple squamoid eccrine ductal carcinoma: A diagnostic challenge beneath the tip of the iceberg.

Eccrine carcinomas are a rare tumor entity which originates from eccrine glands and comprise <0.01% of all cutaneous tumors. Eccrine carcinoma subtypes are classified based on their distinct histopathological pattern. Squamoid eccrine ductal carcinoma (SEDC) is a rare subtype, characterized by both squamous and adnexal ductal differentiation, and resembles squamous cell carcinoma on clinical examination. Given the rarity of these tumors, there remains a lack of clear diagnostic criteria or treatment guidelines for the management of SEDC. We report a rare case of SEDC with perineural invasion in an elderly gentleman who was treated with wide local excision.

Endovascular Thrombectomy for Low ASPECTS Large Vessel Occlusion Ischemic Stroke: A Systematic Review and Meta-Analysis.

BACKGROUND: The current American Heart Association guidelines for acute ischemic stroke reserve Grade 1A recommendation for the use of endovascular thrombectomy (EVT) for patients with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of ≥6. OBJECTIVE: We aim to determine the safety and efficacy of EVT for large vessel occlusion ischemic stroke patients with low ASPECTS (5 or less). METHODS: Medline, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for studies appraising the outcomes of EVT for low ASPECTS ischemic stroke. A meta-analysis of proportions compared the clinical outcomes of patients undergoing EVT and those receiving best medical therapy only. RESULTS: Nine studies (1,196 patients) were included. There was a trend (p = 0.11) toward a higher rate of symptomatic intracranial hemorrhage (sICH) in the EVT group (9.2%; 95% CI 6.1-13.6; I2 53.37%) compared to the medical group (5.5%; 95% CI 3.7-8.1; I2 0%). There was no difference (p = 0.41) in the pooled 90-day mortality of EVT patients (30.7%; 95% CI 21.7-41.5; I2 84.23%) and medical patients (36.6%; 95% CI 26.4-48.1; I2 76.2%). EVT patients had better (p = 0.001) 90-day outcomes, with 27.7% (95% CI 21.8-34.5; I2 62.08%) of patients attaining a modified Rankin Scale of 0-2 compared to only 3.7% (95% CI 2.3-5.9; I2 87.21%) in the medical group. CONCLUSIONS: This meta-analysis demonstrates a trend in higher sICH among low ASPECTS patients undergoing EVT. Despite this, a significant proportion of this subset of patients still achieved good functional outcomes at 90 days. Randomized trials are necessary to substantiate this result as significant bias is inherent in the observational studies included in this review.

Endovascular clot retrieval for M2 segment middle cerebral artery occlusion: a systematic review and meta-analysis.

BACKGROUND: Endovascular clot retrieval (ECR) is the standard of care for acute ischaemic stroke due to large vessel occlusion. However, isolated occlusion of the M2 segment of the middle cerebral artery (MCA) was underrepresented in the landmark trials. AIMS: Given the potential treatment benefit associated with M2 MCA occlusions, we aimed to evaluate the outcome of patients undergoing ECR for M2 occlusion. METHODS: We conducted a systematic review and meta-analysis of the available literature that included patients with M2 MCA occlusions who underwent ECR. Successful reperfusion was defined as a treatment in cerebral ischaemia score of 2b-3. Good outcome was defined as a modified Rankin Scale score ≤ 2. We also analysed complications such as post-procedure symptomatic intracranial haemorrhage and mortality at 3 months. RESULTS: Fifteen studies including 1105 patients with isolated M2 occlusions were analysed. Successful reperfusion occurred in 75.4% (95% confidence interval (CI) 67.7-84.1%) of patients; good outcome was observed in 58.3% (95% CI 51.7-63.8% of patients. The rate of symptomatic intracranial haemorrhage was 5.1% (95% CI 4.2-8.3%), and 3-month mortality rate was 12.2% (95% CI 10.4-16.3%). CONCLUSION: The outcomes of ECR treatment of M2 occlusions are favourable, with good safety profile. Comparison to medical management from large registries or randomised controlled trials is warranted.

Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review.

BACKGROUND: Hip and spine pathology can alter the biomechanics of spino-pelvic mobility. Lumbar spine fusions can reduce the mobility of the lumbar spine and therefore result in compensatory femoral motion, contributing towards dislocations of THA. PURPOSE: This meta-analysis aims to determine the effect of pre-existing spine fusions on THA outcomes, and complication profile including hip dislocations, all-cause revisions and all complications. METHODS: A multi-database search was performed according to PRISMA guidelines. All studies that compared patients who underwent THA with and without prior SF were included in the analysis. RESULTS: Ten studies were included in this review, consisting of 28,396 SF THA patients and 1,550,291 non-SF THA patients. There were statistically significant higher rates of hip dislocation (OR 2.20, 95% CI 1.71-2.85, p < 0.001), all-cause revision (OR 3.43, 95% CI 1.96-6.00, p < 0.001) and all complications (OR 2.83, 95% CI 1.28-6.24, p = 0.01) in SF than in non-SF THA patients. When registry data were excluded, these rates were approximately doubled. Subgroup analysis of revisions for dislocations was not statistically significant (OR 5.28, 95% CI 0.76-36.87, p = 0.09). While no meta-analysis was performed on clinical outcomes due to heterogeneous parameter reporting, individual studies reported significantly poorer outcomes in SF patients than in non-SF patients. CONCLUSION: THA patients with SF are at higher risks of hip dislocations, all-cause revisions and all complications, which may adversely affect patient-reported outcomes. Surgeons should be aware of these risks and appropriately plan to account for altered spino-pelvic biomechanics, in order to reduce the risks of hip dislocations and other complications. LEVEL OF EVIDENCE: II (Meta-analysis of non-homogeneous studies). These slides can be retrieved under Electronic Supplementary Material.

Complications of cervical total disc replacement and their associations with heterotopic ossification: a systematic review and meta-analysis.

PURPOSE: Although cervical total disc replacement (CTDR) is perceived as a safe procedure, no review to date has quantified the complication rates. Of note, heterotopic ossification (HO), one of the complications of CTDR, is hypothesised to cause adjacent segment degeneration (ASDegeneration). This association has not been proven in meta-analysis. Hence, this systematic review and meta-analysis aims to investigate the pooled prevalence of complications following CTDR among studies that concomitantly reported the rate of HO, and the associations between HO and other complications, including ASDegeneration. METHODS: Literatures search was conducted in Embase, MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials. Complications were stratified into ≥ 1 and < 2 years, ≥ 2 and < 5 years, and ≥ 5 years follow-up. Subgroup and meta-regression analyses were performed. RESULTS: Fifty-three studies were included, composed of 3223 patients in total. The pooled prevalence of post-operative complications following CTDR was low, ranging from 0.8% in vascular adverse events to 4.7% in dysphagia at short-term follow-up. The rate of ASDegeneration was significantly higher at long-term follow-up (pooled prevalence 36.0%, 95% confidence interval [CI] 22.8-49.1%) than that at mid-term follow-up (pooled prevalence 7.3%, 95% CI 2.8-11.8%). Multivariate meta-regression analysis demonstrated that ASDegeneration was independently and inversely correlated with age (p = 0.007) and positively correlated with HO (p = 0.010) at mid-term follow-up. At long-term follow-up, ASDegeneration was still positively correlated with HO (p = 0.011), but not age. Furthermore, dysphagia was inversely associated with HO (p = 0.016), after adjustment for age and length of follow-up. CONCLUSION: In conclusion, HO is associated with ASDegeneration and dysphagia.

Pediatric psoriasis and association with cardiovascular and metabolic comorbidities: Systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: There is an increasing volume of evidence which supports the link between psoriasis and cardiometabolic risk including obesity, metabolic syndrome, diabetes, hyperlipidemia, and myocardial infarction. Although one-third to one-half of psoriasis cases start during childhood, it is unclear whether childhood psoriasis is similarly associated with a cardiometabolic risk profile. METHODS: Electronic database searches were performed to identify studies comparing the proportion of pediatric psoriasis cases with controls in terms of dichotomous outcomes including the proportion of patients with overweight BMI, obese BMI, metabolic syndrome, diabetes, hypertension, hyperlipidemia, ischemic heart disease, or heart failure; continuous outcomes recorded include BMI, systolic blood pressure, diastolic blood pressure, HDL, LDL, triglycerides, and total cholesterol. RESULTS: A statistically significant association was found between pediatric psoriasis and overweight/obesity as well as waist:height ratio >0.5, in addition to metabolic syndrome, diabetes, hyperlipidemia, hypertension, and cardiac ischemia and failure. The association with obesity is dependent on the severity of disease, where moderate-severe psoriasis patients have higher odds of obesity compared to mild psoriasis. CONCLUSIONS: Our systematic review and pooled meta-analysis demonstrate a significant association between childhood psoriasis and obesity, central adiposity, and other cardiometabolic comorbidities. Clinicians should consider the assessment of comorbidities in children with psoriasis, which may allow for early lifestyle interventions and education.

Dipeptidyl peptidase-4 inhibitors and bullous pemphigoid: A systematic review and adjusted meta-analysis.

BACKGROUND/OBJECTIVE: There have been a number of case reports and small clinical series reporting the potential association between dipeptidyl peptidase-4 inhibitors (DPPIs) for diabetes and the onset of bullous pemphigoid (BP). The aim of this study was to assess the association between DPPI use and BP, and whether this varied according to DPPI type. METHODS: We performed a systematic review and meta-analysis according to PRISMA guidelines. We identified five studies with cases and controls. We performed unadjusted and adjusted meta-analyses to assess the potential association. RESULTS: Adjusted meta-analysis revealed significant association between DPPI use and BP (OR 2.13, 95% CI 1.59-2.86, I2  = 46%, P < 0.00001). This association was stronger between vildagliptin and BP (OR 5.08, 95% CI 1.70-15.19, P = 0.004) compared to linagliptin (OR 2.87, 95%CI 1.06-7.79, P = 0.04), and no association was found between sitagliptin and BP (OR 1.29, 95%CI 0.79-2.08, P = 0.31). Subgroup analysis demonstrated that the association between DPPI use and BP remained significant in males (OR 2.35, 95% CI 1.46-3.78, P = 0.0005) and females (OR 1.88, 95%CI 1.10-3.22, P = 0.02). CONCLUSIONS: Limitations were that studies reviewed were retrospective by design which are susceptible to bias and lack of randomisation. Our adjusted analysis supports a significant association between DPPI use and onset of bullous pemphigoid. Vildagliptin had the highest odds of BP. These findings have clinical implications for dermatologists and the management of patients with diabetes and being treated with DPPI agents.